thank you so much for coming on and agreeing to talk to all us about the importance of nih. i am an early career scientist myself. i just received my phd from the university of the miscellanea. -- of pennsylvania. i was watching many of my friends in the graduate program rapidly wrap up their phd's and stop experiments they were working on in order to move fo rward with the way grants were being lost from different labs. andft the area of research am now pursuing a career in science policy. i am working with a public education advocacy group in the district. i was wondering if you have any

suggestions for early career scientists. how should we keep moving forward in these next couple of years? it is going to remain tough, even if we reach some sort of a deal. are the voice that i am most concerned about. i am glad you are moving in science policy. we need expertise there. many people in your situation would like to continue to do research and are finding it challenging to identify the path forward for them to do so. nih, we're doing everything we can to provide that kind of support. we are increasing the grants that are a bridge between a postdoctoral fellowship and an independent faculty position. we are making it possible for individuals that come in for their first nih grant

application to only compete against each other instead of the established investigators that may have more of a track record. trying to give first-time investigators a leg up. thatl have to recognize while this is a historic downturn, the case for nih support is so strong, support for nih is so strong across parties and houses in the congress that if we could get past this very difficult time for our nation fiscally, we should get back on a stable track and people should be optimistic that we are going to get there. week whenul that next we hear what has come forward thatthe murray ryan group, we will see an opportunity to get past what has been a real stalemate in decisions towards a solution that has bipartisan support and gets us back on a caning were sequestering be written out of history books and we can be put back on a stable footing. or thecare about health

economy, because when nih does is a wonderful support of the economy with a remarkable return on investment in all of those grants that are going out to all 50 states, we get something like you to fold return in ln the first year. this case is so strong, it has to win the day. whoof the young scientists are listening, hang in there. we are going to get through this. host: for more information on largestch has the hospital dedicated to clinical research, more than 23,000 unique patients in 2013. i want to follow-up on her point. she is studying narrow science. you said that is -- neuro science. the human brain is the

most complicated structure in the universe. -- the ability to make sense out of that has seemed out of reach for most of the time that we have been studying neuroscience and biology. president obama announced a new step in that direction. the human brain initiative, which aims a combination of research from nih, nsf, darpa, private foundations, from companies working with the international community to try to figure out how the circuits in the brain work. that is an amazing frontier to competently -- to contemplate. we can take images of the whole like pet scans and

mris scanned and ct scans, or the space in between, where the action happens, is out of reach. this is a long-term investment. we should be able to figure those things out. how do you process visual information? how do you lay down a memory and her cheery bit? -- and retrieve it? all of the brain illnesses that we know of, all of the fundamental information that we have of how the brain works is insufficient. host: we're going to focus more on cancer research, but this is a tweet from jim. the same amount on prostate cancer research as its brent -- spent on breast

cancer? we invest heavily in prostate cancer research. we invest heavily in breast cancer research. great strides are being in -- in what ish of those driving those cancers. joining us from arlington virginia. caller: good morning. i want to tell you that i had a disease. child, add never been diagnosed. and nih i went into nih kept me alive for the next 30 years with more tests. i lived closer to nih and many of the people that work there.

if a problem came up, i was over there. their 30ing care of years ago. -- i had a heart transplant. live -- alivei am , i cannot say enough about nih. host: that is an amazing story. that isstory --guest: amazing story. it is a story i get to hear every day. this is the largest research hospital in the world. a few steps away from where i am right now, two hundred 40 beds, but all of the patients who come protocols. research this is the house of hope. this is where people come when medical practices fail to find

an answer for them and they come here to find out whether research can offer them something. amazing things have been done here. we also have, because you mentioned how difficult it was to come to a diagnosis, many people are out there after many years of medical valuations and still have not arrived at a diagnosis about what afflicts them. theave at program called undiagnosed diseases program. they can come and have their records and all kinds of scans and tests done. a team of about 30 experts corzine over every detail and tries to figure out what is -- s over everyour detail and tries to figure out what is going on. that can lead to dramatic intervention that can make a difference in their lives. we are on the cutting edge. it is an amazing lace to see what goes on. all of the doctors that work

there are dedicated. they could be making more money if they were working somewhere else, but they believe this is their call to public service. their desire to help people brings them here. thank you for calling. big is the physical campus at nih? several hundred acres between wisconsin avenue and old georgetown road. there are many buildings. there are about 17,000 people who work on this campus. it is like a small town with its own fire department, hospital, obviously. an amazing group of talented, dedicated people. about 5000 of these people have doctoral level degree training in science. thatt any area of science you are interested in in the biomedical arena. do you believe that the brain has the power to defeat

diseases of the body by signaling responses at a cellular or other level? the brain is connected to the rest of what is going on in the body. connection is being revealed by the type of science we do now. we used to think of diabetes as a problem with the pancreas not making enough insulin and the liver and the muscles. adipose tissue and obesity being a big contributor, but over the last 10 years, it is clear that the brain is a huge part of this whole circuit and the more we learn about that and the hormonal influences that are even now, surprising us with their complexity. the closer we get to really understanding the disease. that is just one example. we should never think of the brain as being isolated in your head.

it is all an ecosystem. host: jennifer, boca raton, florida. i am a mother in florida and i have two children. i am a mom of a two-year-old who is undiagnosed. we have been through boston children's we have been all over the place. is one of those children they do not understand. the issues that are happening with the funding, one of the things i get intimidated from the lack of interest public funding for rare diseases. protectssomething that the rare diseases for children out there? is there something separate that aside for them to protect the research? host: what is your daughter's condition? caller: she is blind, she has lost her hearing, she is on g20

tubes. oneas recessive genes, for cdg. they are at a loss. we have been all over the place. they have not got a clue. host: thank you for sharing your story. callerguest: you're telling a sy that would let anyone's heartstrings. nobody able to predict what the path may lead to going forward. this is the kind of thing that we would like to do better with. i am glad you are connected with those institutions and i hope they work hard to come up with an answer.

in terms of your question about rare diseases, we feel that is a particularly strong mandate. rare diseases may not get commercial interest is there is a small market. if you consider all of the people that have written diseases and add them, even though they are individually about 7000 and. about 25 million people in the united states are affected with a rare disease. that is a lot of people. of those 7000 rare diseases, there are only effective treatments for about a hundred of them. this valley of death between knowing the cause and figuring out an answer. have therapeutics for rare and neglected diseases located within the new national center for advancing translational sciences. that aims to try to find a path

across that valley of death for ine diseases, working collaboration with universities and whatever it takes to come up with answers. we are dedicated to that. our clinical center, this 240 aboutsearch hospital, half of the patients there have rare diseases. this is often times the only hope they have of getting answers to a disease that is sufficiently uncommon that most of the doctors they have seen -- have never before seen a case. we have some numbers. a comparison of breast cancer research to prostate cancer. a hundred million dollars is being spent for breast cancer prostate7 million for $800 million is being spent for breast cancer and about $257 million for prostate cancer. 10 years ago, the total

budget for nih was only slightly less than it is now. it was about $27 billion. we are at $29 billion now. inflation eats away at that buying power. our ability to do research, we have received about a 25% cut. particularly with the sequester hitting us hard last march. that is something we hope will go away with this next fiscal year. that sequester men there were about 700 research grants that we were on the brink of awarding that had scored in the top echelon of the grants that we had received last year, and we had to turn them down. have of those grants might been the next breakthrough in cancer? which investigator might have gone on to win the nobel prize that has gotten discouraged and given up? we will never know. that opportunity is gone. that is heartbreaking.

we have to do everything possible to get this turned around so that does not keep happening. host: mark is joining us from ohio. morning, dr. collins. it is nice to talk to someone who understands the importance of science in our world. because io call you have been a type one diabetic since 1964. i am healthy. i take care of myself. i understand the brain's impact on the disease. all -- i think i can help the diabetic community. couldre anyone at all i .alk to at nih i have tried to get through and have had very little luck. i think i can help the diabetic world right now.

with my knowledge of the disease since 1964. guest: you are a remarkable example of how well people can do taking care of themselves and taking advantage of the advances that have happened with type one diabetes. you are telling me you have had years.agnosis for 50 there are individuals like yourself who seem to do particularly well with the long- term consequences of a disease that carries many rests in terms of what it does to kidneys and to eyes. yourself are of interest to figure out what are you doing that has been so effective. i am sorry you have not been able to get anybody at nih to respond to your offer of help. i would encourage you to do so again. the institute that focuses on diabetes is called the national institute of diabetes, congestive, and kidney diseases. niddk.

there go to the website, must be on their homepage for niddk, an opportunity to send in a query. please do that and see if you get a response. you're sorry -- your story sounds interesting. on a i went to conclude follow point. you have discussed sequestration. what about private medical research? who is doing it and how does that impact nih? guest: we depend on partnerships with private foundations, as well as private industry. this is an ecosystem where all the participants need to be vigorously healthy for the whole thing to work. in terms of foundations, we work with many of those that are focused on particular diseases. just this past monday, delegates was here and we had a very interesting -- bill gates was here and we had an interesting day working together on hiv- maternalerculosis,

health. with the private sector, if we are going to see success and developing new treatments for diseases, that partnership is the only way it is going to happen. nih contributes to the fundamental information that leads to new insights about therapy. we do not make pills, the industry has the next step in the pipeline to carry that over to the point of an approved therapeutic. are working more closely with industry right now today than at any time in the last 30 years. both because of the scientific process -- promise and because of the knee. dr. francis collins is the director of the national institutes of health. thank you for beginning our program on c-span's "washington journal." we appreciate you coming and explaining what you do. hope people will stick around and listen to some of the institute directors for specific areas you will find very exciting. host: that includes infectious

diseases, cancer, and mental health of the next two hours on "washington journal." thank you very much. we will continue with more of your phone calls. a chance for us to hear from you your thoughts about nih research. dr. anthony fauci will join us. alan is joining us from arizona. morning.i, good i would like to talk to a doctor. can i call back? like to ask would to us had research given on c-span regarding the cancer percentage in india being about 95 per one million versus 1000 per million here in the u.s. seminar, the gentleman mentioned that the tumeric was an

instrument will part of dietary supplements in india. it was derived from the cumin root, it attacks the blood supply of a cancer. it would be nice to ask the next regarding mr.up up after -- naturopathic vitamins or minerals or things that could be helpful. bring that up when we talk to dr. harold varmus, director of the national cancer institute. thank you for the call. nancy, good morning from pennsylvania. was in my daughter continual pain as an athlete. she was finally diagnosed at the national institutes of health with an obscure generic disease. i also wanted to talk to dr.

cancer research being done at md anderson, which focuses on a radio type attack of cancer cells. i am wondering if somebody might mention that. have a great day. host: thank you, we are familiar with that research. try to focus on that. we will bring that up with dr. varmus. memphis, tennessee, good morning. democrats line. caller: thank you for taking my call. i want to speak out for the animals that are being used in research. i think that the tests are redundant. a lot of the information can be gained by other means. that sortimulation, of thing. if animals have to be used to

gain knowledge in this area, then the information should be shared throughout the different institutes. rather than doing tests over and over. nobody is talking about that, i want to speak for the animals. thank you. host: thank you for the call. we are at nih and we want to welcome to c-span's "washington southey,dr. anthony who heads up infectious disease studies at nih -- dr. anthony fauci. host: let me begin with the questions you are asking yourself and your researchers about infectious diseases? diseases,h infectious there are two major buckets. there are those diseases that are established. we essentially can predict what

the domestic and global more global morbidity and mortality would be. we have research to develop diagnostics when we have them. vaccines andr therapeutics. then we are faced with the threat of new, emerging, and reemerging infections. things that we would not or could not have predicted. we were faced with that situation in 1981 when the first cases of aids were recognized. we had never seen that and we had to get very quickly and address that from a scientific and public health standpoint. now, today it has evolved into historically one of the most devastating pandemic in our civilization's history. there are things like the threat of pandemic influenza or sars a few years ago, or the merz coronavirus. we constantly need to be on guard and be able to respond

scientifically so that we can develop from a concept to an orervention or prevention treatment. that is what i refer to often when we talk about this as the perpetual challenge of infectious diseases. of the headlines from "the new york times," a story getting a lot of intention. concern from college students and parents, meningitis outbreaks striking to colleges. we are familiar with what happened at princeton. uc santa barbara. the disease in flames the linings of the spine and the brain. guest: is a clinical diagnosis that can be confirmed by laboratory data. to outbreaks, one in princeton and one at the university of california santa barbara. meningitis is a big. that can be quite devastating --

is a bacteria that can be quite devastating. one of the students at uc santa barbara had a complication that required amputation of their feet. even though this is fundamentally a disease of the brain,the lining of the it can have a replication of these bacteria, which can cause a variety of catastrophic symptoms and signs in the individual. a critical way to address this. for this,treatments antibiotic treatments. the critical way is prevention by vaccine. we vaccinate young people, particularly those about to go to college, with meningococcal meningitis vaccines. but there are multiple subtypes of this. the one that has stricken intonts in princeton and barbara are what we call the subgroup b of the meningococcal us.

be vaccines does not contain because it has not been submitted for approval by the fda. what is happening now and will be happening in a couple of days through the collaboration of the cdc and the fda, the young students and the students in the dormitories are going to get vaccinated by special permission from the fda and the cdc with this vaccine. subgroup.ins the b it does not happen frequently. there are only about 500 cases of midget cockle meningitis -- of meningococcal meningitis per year in the u.s. about 160 of those are from the subgroup b. it is devastating when you get these outbreaks as we have seen that princeton and santa barbara. host: are there early warning signs? what should an individual look for? the early symptoms are

fever, headache, stiff neck. then you start to feel a syndrome.g flu like the fundamental issues -- it involves the brain and the covering of the brain. stiff neck.ver, and the critical issue that people -- the students and the officials at the universities -- it is generally spread by very close contact. that is why the most vulnerable people are people who are in relatively confined spaces like in a university dormitory. barracks when you have soldiers and marines and others in barracks. they become more successful -- they become more susceptible. it is spread by saliva and respiratory secretion. do not share utensils or food, avoid kissing and intimate contact, which is the thing that spreads this disease. host: wayne is joining us from

washington, d.c., welcome to the program. caller: i called in when dr. collins was on. i'm not sure if dr. soucy is independent with this. the humane society is attempting to drive a movement towards alternative animal research. i wanted to come and dr. collins and the nih for its very wereous efforts that rigorous in terms of signs in recognizing in chimpanzees -- in recognizing that chimpanzees are unnecessary for invasive experiments. they worked hard with congress panelnvene a scientific to examine this. they are beginning the process of transferring the majority of chimps in laboratories to sanctuaries which are accredited. i wanted to thank him.

we need to balance animal welfare with scientific pencils. -- scientific principles. host: thank you for the call. dr. fauci? guest: we are very sensitive to the humane aspects of research on animals. research on animals is the -- is essential to the help of the world. you have got to do it under the most humane conditions. was correct, it is clear that experiments that have formally been done in experiments that we are now looking for other ways and have found other ways to get the same answer without using chimpanzees. host: this is a tweet that wants to know would protocol out testing in one country to be accepted in another country? cutting the cost and time for drugs to market. guest: yes, but you have to pay

attention to ethical principles. we do this. if we have experimentally clinical trials in foreign nations, particularly developing nations. the principle is that it has to a resulty wind up with that could be beneficial to the country in which you are conducting the experiment. to do an experiment or a whereal trial in a nation if you got a result, it would not be relevant to that nation, that is fundamentally unethical. you can do an example -- an experiment in a foreign nation that would benefit the nation. adhere to the highest ethical principles. it could have the global benefit, including in the u.s. you cannot exploit other nations an experimental way that does not clearly have a benefit for them. is the director of the nih allergy and

infectious disease program. joining us from maine. caller: thank you for taking my call. i am a retired physician. i trained at bethesda naval hospital across from nih. i have great respect for the fabulous institution. my question concerns line disease.- lyme it seems that there has been controversy, even in the professional community. about whether there is such a thing as lyme disease. i wonder if dr. fauci could comm ent. guest: there is a disease called lyme disease. it is a disease you get from a tick bite. is named after an nih scientist who discovered what it is. if you and it is named after a scientist that actually discovered what it is.

and the controversy that the caller is referring to is the fact that there are situations where someone has what has been called chronic lyme disease were months and months of a possible tick bite or acute infection and many of them get overdiagnosed, some are undiagnosed, and the question is what is the therapeutic approach with regard to therapy and there have been recommendations from very long courses of antibiotics, which a number of groups that have looked at that and have found out that that has not been official and can actually be harmful because of the duration of it. but it is clearly an aerial of some controversy. but lyme disease, as a disease, it certainly does exist.

>> host: do you know why people get asthma? can you respond? >> guest: it is a complicated issue that has to do it environmental and genetic predisposition. asthma is part of a hypersensitivity or an apparent response to a particular antigen , that in most people, most of the population -- you get exposed to it. like a respiratory antigen or what have you, where it would not really bother many people were most people. but with those that have a previous condition to asthma, it triggers a series of a release of chemical mediators, which comment the nominating response is that the lower airways, we call them bronchioles or the part of the lung that allows the air through, it is a disease of what we call constricted

airways, where the aberrant or abnormal response is a constriction of those very small bronchial tubes which does not act normally and you have a typical wheezing sound and the air gets trapped because of the constriction of the bronchioles. a lot of the genetic predisposition is a combination of environmental and genetic factors. >> host: we have our guest to a's 80 graduate of cornell and why did you decide to stay at a young age at the nih? >> guest: i finished at the cornell medical center and after several years of training and internal medicine, i wanted to do a fellowship that combined in

immunology and i came to the nah nih that was basic and clinical and i fell in love not only with the concept. with discovery in science it has to do with help, health, but with the extraordinary electricity of atmosphere here at the nih. so i went back for a year for my clinical training. and the fascination of the interaction and communication -- sometimes we joke around, but it's not a joke. it is such an exciting experience. >> host: we appreciate the chance to talk to you and this past week the president talking

about aids as part of world aids day. and another $100 million in aids research. here's what the president have to say. we will get your comments in reaction afterwards we macri announced an additional $35 million for the aids assistance program, which helps people pay for life-saving medications and that one time they need was so great that over 9000 people were on the wait list. we vowed to get the numbers down and i am proud to announce that as of last week, we have cleared this and we are hoping to get it back. [applause] so we are making progress. and we remain to see how much work will be done. we need to continue keep up the

fight, including in washington dc, which in recent years has reduced the diagnose infections by nearly half. and we then we are going to keep pursuing scientific breakthroughs. i am pleased to announce a new initiative of the national institute of health for an hiv cure. we are going to redirect $100 million in this project to develop a new generation of therapies. because the united states should be at the forefront. including lifelong therapies, and better yet, eliminating such things completely. >> host: we are speaking with our guest today. how close are we to finding a cure for aids? >> guest: you have to think of a cure realistically and it is impossible to predict how far we are away from that. but people do sometimes get

confused between the difference of the aids pandemic and everyone who needs to be on treatment to the point where they can essentially live a normal life and it means that you put someone into a sustained remission without the need for therapy without being indefinite. like when you hear someone of another disease. and one of the things that you don't want to get confused with is that even though they don't have a cure, we don't have a cure yet, the advances that have been made by the therapy that are related to hiv-infected individuals that prevents infection is really nothing short of breathtaking. right here in the nih in the early 1980s when i began

treating aids patients after the discovery of the new disease. and that means that 50% of all of my patients would be dead in six to eight months, which was just terrible, it was terrible for us were taking care of the patients and those and their families. now, today, if a person comes in during their 20s and you start them on the combination of drugs that have been developed, you could project that they would live an additional 50 years and that is an extraordinary advance from clinical work and a translation into an intervention. so although the cure, being able to tell someone to come off the medication is something that we are aspiring for.

and over three years of essentially accelerated that process. we were very enthusiastic pursuing this cure. that is something that is a very difficult to predict. >> can you explain what is the global fund? very briefly? >> it is a multilateral and it is, it is an organization that is based in geneva.

especially to treat and prevent and care for people with those diseases and the united states of america is the largest by far funder of the global funds and we put in about one third of all of the money that goes into the global fund, including for other countries. so it is a major component of how we address these diseases. and it is an extraordinary organization the reason we are talking about this global fund is that just this week we have this replenishment meeting where those from all over the world came from washington dc to make pledges for the amount of money that they would be putting into the global fund over the next

two years. and this includes a process which takes place right here. postmodernists call comes from tom in texas. thank you for calling into the program. >> caller: thank you for taking my call. i am extremely interested in the treatment of adult leukemia and it started when i was about seven years old and a juvenile and i didn't know what they were doing in the 50s. and i am now 54 years old. and he spent a year with his family and they said that he was making progress and all of a sudden he was gone. and i saw a two hour nova they

have indicated that there have been some progress. >> host: thank you for your call, tom. we will talk to the director of the national cancer institute. so that will be part of it. and leukemia has multiple different types. it is not one-size-fits-all. and so it actually blocked the particular component of a genetic defect in the cell that leads to leukemia for what was otherwise a devastating leukemia

situation. we have a little bit different nuance regarding treatment. >> host: we have been speaking with vicky. >> caller: yes, one more question about the research so that means that if they can use a computer, they would. >> we appreciate the call and

these animal studies are necessary, you can substitute for an animal study and another approach would be preferable, but many things. >> host: the nih spends lots of money. out of about four and a half billion dollars spent for allergy and infectious diseases and jeremy is joining us from hyattsville maryland. welcome to the program. >> thank you. i have two quick questions for the doctor. and this includes scientific research and an on-again and off-again kind of thing and stem

cell research works or doesn't or reproductive kind of research and how much money is wasted by the starting and stopping of that kind of thing? secondly, the idea that there would be a technical achievement in government. to kind of counter the politicians when it comes to medical research and the practicality of this research into engineering and then i'll take the response off the phone. thank you. >> first of all, i think it's important to point out that the

nih therapy years has benefited greatly from bipartisan support. and the budget has been flat for a least 10 years and then we were hit with a devastating effect of sequestration this year, which really needs to be reversed if we are going to get back on track to what we can do for the country in the world of biomedical research on call. one of the caller asked questions about political issues or stopping something. really not much. we are talking about issues that relate that can get in the way and luckily we haven't had a lot of that. we have people who are very much in favor of what we do and we

have been actually very fortunate to have this, for the most part, but for the most part total universal support for what we do. what we do is generally left after us. >> there have been two final points in the research of genital herpes and the possibility of determining a cure or a treatment in that area. >> guest: the real challenge is with the vaccine of genital herpes. and they can suppress the issues and it can be a part of a acute attack of mental intermission temporarily and then they get an outburst of infection. that is troublesome to the people who are infected. the good treatments have done

much better than the vaccine research. we haven't had overwhelming success and we have had a disappointing failure in a type two herpes vaccine, a relatively short while ago. but we have a number of new initiatives not only here in entrepreneurial programs, but in bethesda, maryland, but with her grantees and those to put two put another really good full-court press on trying to develop a good herpes vaccine. >> host: what is the outlook for the upcoming flu season? >> we have a seasonal flu every year and sometimes you have a very early start to the flu season and they tend to get over

it by the end of march and the beginning of april and we start to see some cases trickle in. we are starting to see it now and it is mostly light activity in the country, a couple of states like texas and mississippi have pretty heavy activity. and so it seems to be relatively on target and it looks like the beginning of a pretty typical flu season. >> host: we have the director of the infectious diseases center and that makes up the nih conflicts. >> 10 years after the completion of the human genome project, we will be checking in with doctor eric green who is the director at nih and it's a couple of

minutes left to get your it calls on that topic. >> good morning, doctor. >> caller: you mentioned that with 27 various institutes, they operate in terms of their i.t. infrastructure as well as thinking about how to pool and manage all of those i.t. resources to reduce redundancy so that those assets can be used more broadly. >> host: sam is next. welcome to the program. >> caller: good morning. welcome to the doctor. i recently was diagnosed with multiple myeloma. i am supposedly a candidate for

stem cell research. but what i want to ask the doctor about is what exactly, why do they call it multiple melanoma? are there any other racers with this type of chance. >> host: where have you gone for treatment? >> caller: i have gone to the va center is. >> host: how would you rate your care? >> host: and we also have another caller. >> the doctor, we definitely enjoyed his opinion.

i am a little facetious, but you get my point. >> host: we have a caller from west palm beach, florida. >> caller: hello, thank you. are you there? >> host: yes, we are [inaudible] >> caller: what is the difference between hiv and full-blown aids and also [inaudible] >> host: you can click on

nih.gov and we have this information with them on a website we have another caller >> caller: my daughter gets an infectious disease and and alsor bones are dying and i'm wondering if this is connected or if there is something that should be treated separately. a. >> host: thank you for sharing your story with us. you can get more information at nih.gov. we are looking at some of the latest researchers and we want to introduce you to the director

of the national genome institute, doctor eric green. thank you for being with us and we appreciate it. >> guest: happy to be her. >> host: ten years after the completion of this project, what have you learned? >> guest: it wasn't ever that went on from 1990 through 2003 and it's a very large international projects. the goal was to sequence the human genome and to read out all of the data that we need. this includes understanding biology and also to learn more and more about human disease, in particular the aspect of disease that relate to heredity. that project ended in 2003 and were wildly successful and it really has set up a circumstance for us to now begin to use genomic information and with the tools of reading out human dna to better understand the role

that dna plays. >> guest: the first thing to keep in mind, there are differences that lead to getting a disease or being in a statistical risk to getting a disease and in some cases, rare diseases might actually cause a difference and it causes a particular disease. you asked about risk factors in particular and we have learned a lot in the last 10 years, mostly because we have been organized to do studies that allow us to take thousands of individuals

with or without a disease like hypertension or diabetes and increasingly studied the dna of those individuals and find out which sequence difference is in our dna are associated with getting a disease. and that is giving us insights about what can go wrong in human biology that would lead to a disease like this and it gives us some idea about how to move forward development of new drugs and eventually we are hoping that some of these things will lead to diagnostic opportunities using opportunities about their unique genomes. >> host: looking at the overall budget of about $31 billion and the research being conducted at the human genome research institute totaling about $513 million. >> that was before sequestration. we ramble of 500 million after

sequestration. >> host: what can you expect in the year ahead? >> guest: we do not know, that is why we are operating at last year's level and then we have to see what congress does. and there is a possibility of having additional sequestration cuts which would be even more devastating to the research in the country. >> guest: let me put a couple of issues on the table. can you determine whether an event is predisposed to sudden infant death syndrome or whether he or she may be predisposed to diabetes or later in life to alzheimer's and dementia? >> a long-term view is will we be able to take an event and learn a lot about this or later in life, other diseases, but also we are very interested in

knowing how the genome might make it the particular drug would be a good job for them to get it or it might be bad drug for them to get what the right dosing might be in there is a law involved in how we respond to medication that is scripted in our genome. right now every baby born in america has a genetic testing done, with a small number of conditions which can be early intervention that ends up being healthier or at least you know what to you protect that child list or how to handle this. that is really only a few dozen conditions and now we know about the genomic basis for literally thousands and thousands of rare diseases and overtime we will learn about these more common diseases as well. indeed, we are very interested in what will the future be like when it becomes straightforward

to sequence a baby's genome and have that information available starting when they are infants. and just this year we have launched a new research program and we did this in collaboration with another institute to really develop a research program that would allow us to study exactly what you describe, what that future will look like. sadly we were only able to fund it at about half the level that we had planned because of these budgetary constraints. >> host: what would you tell congress? >> guest: i would tell them that we invested beginning with this project and really, i think we have been very insightful of recognizing that the u.s. could be a leader in genomics in a field that is incredibly exciting and explosive in terms of its accomplishments and has been wonderful to see these of congressman's bear some important fruit. yet we are finding ourselves at our feet on the brake pedal because unfortunately we can't

fund all the research that we know needs to be done to really see these clinical advances come to fruition by using this information about patients. >> host: we are talking with doctor eric green and also washington university graduate. what is your background? >> guest: my background as a graduate student, i work on dna and i would point out that when i went to medical school and graduate school, i graduated in 1987 and that was the year that the were genomics first-run to be used and was talked about for the first time and i never even heard the word genomes in medical school or graduate school. but depending on when i do my clinical training in topology, it was at a time that a lot of discussion was sequencing the human genome and i saw the diagnostic opportunities that could someday come to be where you could get the knowledge

about individual patients into gnomic information. and i thought this was too exciting of an opportunity to pass out. so as a trainee in topology, i got a chance to participate in this project from day one and now i find myself on the other end and participating in it for 13 years, and that ended 13 years ago and now we are fortunate to direct this institute that was created by the u.s. congress, explicitly to ms effort. >> host: gene, welcome to the conversation. >> caller: good morning. as far as the research goes, i remember that back in 2011 or 2012, a research company announced a breakthrough in this direction.

>> host: i certainly know that we have an institute that focuses on these autoimmune diseases and i'm sure we can get information and the website is the abbreviation for the institute. some like this and other autoimmune diseases, what is happening now in genomics is opportunities to develop studies where large numbers of individuals are being studied and we are able to look at all of the dna differences that they have versus the individuals that don't have that disease and develop what are called associations between particular regions of the genome and then getting and having a risk for having a disease and there is incredible new insights that are coming out about that. for many autoimmune diseases. completely, we don't understand this yet. that where we are now in our knowledge of where to look in our dna for differences that

might be part of risk, it is really spectacular what is happening. and i think that we can expect between now and the end of the decade remarkable advances in diseases like that. >> host: whether it's medical research criminal investigations, dna plays a large part of that. how do we find out about back we find out about that? what are the origins of the research? >> guest: it goes back many years, really the incremental insights about what the hereditary material was in a major new breakthrough is recognized that dna was clearly hereditary material and one of the most famous discoveries was 60 years ago, we are celebrating that this year. jim watson and francis crick described that iconic structure of dna and it was really a key and pivotal accomplishment, one of the most significant

scientific discoveries in biology over the last century. because it was the insides about this that made us then be able to understand how it was that dna was the molecule they carried all the biological information from generation to generation and what has happened since the 1950s has been better technologies with new insights, learning how to clone dna and sequenced letters of dna and then figure out how to weed out all of the dna of an organism and the genome of an organization like humans, where humans are increasingly like patience. >> host: we have the director of the research institute, institute, tom from tuckerton, new jersey. >> caller: good morning. am i correct in understanding that people are associating this

in a problem with their genes and we may have a genetic predisposition to some problem and it's that behavior that allows that genome, that predisposition to express itself and that is manifesting in a disease. >> guest: that is more complicated than that, but you make a very complicated and important point. in genomics, dna, this is what i do, this is what we really focus on, but i don't want to leave you with the impression that all disease or everything we do is completely scripted and there is no other influence. there is other influences. we are talking a lot about genomics is because we have this remarkable technological surge in our ability to weed out dna and to be able to study the differences for getting disease. but you make a great point. some of these things give us a predisposition, but that doesn't

mean that we will get this. the environment, the behavior, the social aspects of life, all of these things are influenced and it is the interplay, especially for these were common diseases like hypertension and diabetes and so forth. we know that there is an interplay and a genetic predisposition of what you are eating and how much exercise you are getting and so on and so forth. so this is where it gets very complicated, but i want to make sure that i emphasize that the genomic is a key part of this puzzle. >> host: we have doctor eric green, please go ahead with your question or comment. >> caller: hello, i was in vietnam and i caught malaria and when i came back to fort bragg, i had a relapse. i am having problems and i cannot hear that well.

and i have these warts or what whatever growing out of me and the va cut it out. what kind of long-term effect will this have? >> the person that spoke with me on these interviews would really be the expert on that. this is an expert on infectious disease and we have a world expert on that. we have the institute that he runs, hoping to get those insights and what i will tell you to make this point is that a disease like this, it is a complicated disease, infectious disease, because it involves not only the malarial parasite but mosquitoes and other vectors that carry that that end up being the way to they humans get infected and of course there are humans. in a situation like that, there are three genomes. there is the human genome and the mosquito genome and then

there is the malarial parasite genome. and the tools of genomics that were developed for the human genome project have similarly been used for being able to weed out the dna because all have the same on the mental dna properties in terms of what they are made up of. and this includes malarial dna, mosquito dna, we are learning so much about the interactions of these genomes and that is advancing our knowledge of this that is substantial. >> host: what about advancements and the type of prescriptions that you might get and couldn't be tailored to individuals based on the dna? >> guest: you're talking about prescriptions and individual medicines. this is an exciting area and it's already here now. it is called comical genomics for pharmacology and drug prescriptions and so forth and then genomics as well. and i talk a lot about the

diseases. but there are differences between genomes, they can also influence how we metabolize drugs and respond to medications. i remember it being taught many times that you try a patient and if it doesn't work, you try a different one. the reason it doesn't work for half the people, is because those individuals have different genomic variants to make it so they don't metabolize fat as well or they metabolize it too quickly. so we are learning a lot about which differences play a role in whether you are a good responder or a bad respond or you need to does them at a different level and already it requires labeling this and they say the genomic medication might be relevant for prescribing meds. and i can guarantee you that that list of drugs is going to grow substantially with time and it really is now part of

standard to get this before deciding whether to give them that medication or what dosing to use for that medication. >> host: we have gordon from laramie, wyoming. >> caller: good morning. thank you to c-span and thank you for your service and your humanity, doctor. >> guest: thank you. >> caller: i hope that nih is getting funding from private sources as well as government. i hope that that will be the case. also, paul mentioned the behaviors are area i have heard through independent sources that strenuous exercise and an antiviral anti-carcinogenic situation,.

>> guest: let me answer some of that. there is some of that goes on, some of it goes on and it's a private foundation that raises funds on behalf of nih and there are many collaborative projects that are done with researchers and the foundation. i will also tell you that the nih works in partnership with many different private sector entities as well as other fundings near the country and around the world. and this is biomedical research where the nih plays this and we do this in a very close partnership with the private sector and our own foundation and other agencies in this country and elsewhere. the question that you ask about exercise and how that has been shown to have a result in the production of chemicals, absolutely.

this is why your doctors and other health care professionals are saying that this is important for keeping your weight where it should be and also because people exercise a lot and they tend to be healthier. some of which we understand and many that we don't yet understand. all of the biological reasons. >> host: boston and new hampshire, the next is charles who is joining us in bethesda, maryland. >> caller: hello, doctor green. thank you so much for your research and we appreciate you and everything that your staff is doing. my questions are the following. where can the general public right now though and have a dna test. and also how much is the test. and what are the ethics on that information? >> guest: those are terrific

questions. we have the capability of weeding out the genome in a matter of a day or two if we want to do and to end sequencing that would cost several thousand dollars. we are able to do that now and the question is should we be doing that now and in which cases. so much of what i institute does it is trying to create the future of the research to answer these questions more precisely. there are certain circumstances where this makes complete sense already and you will hear from the head of the cancer institute and there is excitement about using the ability to weed out dna of tumors and learning better and by having genomic

information and there are other information sectors like where this would make a lot of sense and it's an individual that we don't know what is wrong with them, very rare disease of an unknown type and it now makes sense to see if we can figure out what is wrong by looking at their dna in the detail. so these are situations where physicians are involved in this sequence makes sense. five or 10 years from now, there will be many more scenarios that will make sense. but your question also says this and i should point out that there are companies that are out there that do what is called direct to consumer genetic testing and looking you can find various companies that offer that. and then it goes nicely hand-in-hand and there's a lot

of ethical issues around what are sort of the advantages and disadvantages of individuals having their dna analyzed if you don't have a professional to help you analyze that. some of these companies have generated a lot of interest in genomics and have actually, i think, they have helped to educate individuals about the importance of dna and it's part of the medical care. but it's not entirely clear what information really is useful in the absence of being cared for by a physician and these are things we are grappling with an art institute really take this very seriously and with supporting these genomic studies because we realize the many

issues that need to be considered if we are going to use this as part of the routine medical care in a safe way. >> host: we have about a minute left in her question is from mary in virginia. >> caller: thank you for your research. my question is is there research leading to be in a work to predict when genetic diseases will likely hit, it can skip generations are so and i'm very interested to see if the research will eventually lead to this. >> guest: but i will tell you is that we like to manage expectations and right now we

can weed it out and make some predictions and there are certain diseases that they might get and in some cases we can say with near certainty. but in most cases it is a percentage and we have a twofold greater risk of getting this or that. as an earlier caller alluded to, there are many factors were those that play a role such as environment and other social components of your life. i think in time this will grow. but i would say that some of this with genomics are going to be in areas that are much more concrete and diagnosing whether or not this will be a good or bad responded to medication. certain diseases for which we know that genetics plays a major role. i'm very cautious in predicting this and to be able to take down

not only every diseases they might get and when they are are going to get it and with what certainty. i think it will turn out to be very complicated and we will gain some insights. >> host: we have doctor eric green and he is part of the national institute of health and we thank you for being with us. >> guest: tank you for having me. thank you for allowing us to talk to you. >> host: in just a moment, we have a doctor on cancer research. the cancer rate has been the lowest since 2008 and we have been talking about this issue and we are going to take a short break and when we come back, we will continue to programming and conversations with the leading researchers at nih. you're watching c-span's "washington journal" on this friday morning. >> things escalate so quickly. things can turn and be so out of

control. this was one of those days and we found someone who had a hidden handgun and we said, what is the deal. and she just held the gun and he went in there and came out with a shotgun and really try to jam at her and go to her so that she would pull the trigger and kill him. and this is basically what she told me afterwards. reporter: the u.s. army's second battalion sunday night at 8:00 p.m. on c-span's q&a.

>> dance and play is and that led to burlington, vermont, where she studied at the school of dance. these are her spiral notebooks. and she carried this with her to vermont, back to grand rapids, where she studied with martha graham and worked with the powers modeling agency and then back to grand rapids again. so in that you would find a host of things that you would find in any organization. there are brochures on dance costumes, one of the sketches for one of the dance routines that she wanted to put on and here is the choreography notes that she wanted to make for different dance routines. so there is a wealth of material

that talks about the love for dance and how deeply she was involved in it. especially in her early years. put. >> watch this on saturday on c-span at 7:00 p.m. eastern. our series continues live on monday as we look at roslyn carter. >> "washington journal" continues. >> host: just outside of washington dc in bethesda, maryland, is the national institute of health, it includes 27 separate institutes and centers, including research in various disciplines including biomedical science and neuroscience and joining us live is the director of the national cancer institute, inside the building that we looked at a minute ago. we appreciate you being with us. >> thank you and it's good to be here. >> host: president richard nixon declared a war on cancer. how are we doing today?

>> guest: he signed the national cancer act, but he didn't call it a war on cancer as were many other people dead. it is a dreaded disease that affects over a third of our population and a major cause of death in the country. to say how we are doing requires a complex answer because it is not a single disease, but perhaps thousands of diseases that are characterized by what we now know with the efforts that we have made of a disease that is caused by this and changes in our chromosomes and genomes that we have been hearing about from eric green. we are making progress overall. annually we are reporting to the nation about progress against cancer measured by the best metric that we have. including the age-adjusted mortality rates and overall there has been a decline in this mortality.

this is the good news. but we would like to progress to be faster and there has been much less progress than their house for others and for some others we were able to cure or control the disease in a very effective way and essentially for other cancers we have made limited progress. so it is a mixed bag for the one thing that is relevant for today's conversation is that we have such a greater understanding of the set of diseases than we did 20 or 30 or 40 years ago. but this has a tremendous hope for making faster progress that we are given the resources and having the person i want to carry the research out. >> host: began looking at the numbers in the annual budget of about $30 billion, just over $5 billion goes to the national cancer institute.

>> guest: it used to. >> host: that is my question, what impact has it had on your budget and what can be done if you had the money they make. >> guest: we took over a 5% cut last year and not comes on top of a decade of budgets that were essentially stable and it had been declining. it was operating with the same level of resources that we had around the year 2000, about 25,000 in 2003. do what we have done at the national cancer institute is to try to modulate the effect of these reductions both for the long-term reduction in the short-term acute reduction that we had last year. by trimming across the board and preserving the number of new grants that we can issue. this is not a policy that can be carried out to help protect our

investigators last year and we don't close down the most important projects. we recognize that there are other sources of money from institutions and philanthropy than other societies and industrious and we are not the sole funder. but frankly we can move a lot faster on many fronts that we have more resources. the talents and the background information. it tells us what we ought to be doing. all these things are in place and fueling this very robust enterprise is something that would yield rewards. >> host: a couple of numbers, 65.8%, the present of those that survived cancer fighters and

beyond. >> guest: or can i explain? >> host: that is encouraging news on the high number. >> guest: those numbers have to be worked out fairly critically. but we think that a great piece of evidence that indicates we are making progress, in addition to the best metric of all, which is the age-adjusted death rate that i mentioned. one other way to look at it is by measuring a five-year survival rate. and it's clear that that is an imperfect measure. and if you diagnose this earlier and don't produce any real effect on the cancer, you still may have an improved five-year survival because of what we call leadtime bias and that is a diagnostic of a disease which runs its course. and this is part of some criticism. but it is a measure and it is

important because it does tell us that there are a lot more people in the country today, many are cancer survivors and have it cancer diagnosis and are now equipping themselves for life as individuals who have had an experience being treated for cancer and of course, still after five years there is a recurrence risk of the cancer. the mci pays attention to this and this includes the attitudes of people take in detecting an earlier and how to prevent second cancers and what do individuals who have have been treated for a need to think about with respect to employment and other aspects of life. >> host: according to the nih, there are 1.6 million cases of cancer and in this year, about

580,000 deaths as a result of cancer. and i want to break down the numbers. i want to begin with the top types of cancers. prostate and breast cancer and an estimated number, 230 to 240 cases in the thousands. the estimated deaths, about 30,000 and 40,000. so why we have a high% of this, a very low rate in terms of estimated deaths. ..fe to people who are diagnosed with breast and prostate cancer. in part, that is because we have protection tools. sometimes those reduction tools , whatus to see a change we call a lesion or area of abnormal growth which might not have caused the patient any difficulty even if they had not

been treated. one difficulty dealing with the numbers when one counts the incidents as well as the mortality of her haps prostate cancers is there are many early or diagnoses of abnormalities that might not to cancers.sed one of the problems we face at the cancer institute, one we're looking at with special programs at the moment is how we distinguish damage that is detected early but would never cause the patient any real difficulty if left untreated from those early abnormalities cancer.ld lead to there is a large fraction of dndividuals who are diagnosed as being a cancer patient, and the numbers tell us to include a lot of people who would never ofe been ill or had a risk

lethal cancer if the disease had been left untreated. how we distinguish between those who have something to worry about seriously and those that do not is one of the challenges that we are trying to address with new molecular tools we use in the clinic. host: if you can compare that to one of the leading causes of cancer deaths local lung cancer. this year an estimated 228,000 cases and more than half, 160,000, estimated deaths as a result of lung cancer. guest: there are differences and also differences in the mode of detection. you are aware that there is a new method for detecting lung cancer earlier than before. at the national cancer institute, over about seven years, we carried out a large study called the national lung screening trial in which 53,000 methodused a new imaging

. that method has now been shown by rigorous controlled study. out by the nci to reduce lung cancer totality in heavy smokers, people at high risk of the disease between ages 55 and 75 by about 20%. that is a significant number. it does not compare favorably with the health benefits of not smoking. nevertheless it is going to lead and has led in the past to early diagnosis, and i think some of those early diagnoses will be abnormalities that might not have lead to lethal cancers. but the study shows that this method can detect some lethal cancers early and reduce the fertility from lung cancer -- the mortality from one cancer.

likely once the official report is filed that there will be recommendations for all insurers, including medicare, to cover this method. hopefully we will see additional reductions in lung cancer mortality to add on to what has been achieved already by the dramatic reduction in tobacco use in this country, as well as improvements in therapy, surgery , and drug therapy. host: if you are joining us on c-span radio, our guest is dr. harold varmus, director of the national cancer institute. he has his masters from harvard and also studied at the columbia university college of physicians and surgeons. allen is joining us from new jersey. caller: it is a pleasure to speak with you. doctor, you have talked about st and prostate.

the question i have relates to bladder cancer and the progress that comes and whether or not a treatment that is known as the , if that is the state of the art and if it seems to be very, very promising with regard to eradication of bladder cancer? has proven to be an effective therapy for early- stage superficial bladder cancer. for more advanced stages, other treatments are needed. this may be a place to introduce a concept that i think we need to introduce some time in this half-hour, and that is the dramatic effect of our understanding of the human genome is having on our approach to the treatment of cancer. bladder cancer is among those that have been subjected to intense genetic domination over the last several years thanks to

the development of the new tools that you may have heard about in the previous half hour with eric green. and we will have to be subdividing bladder cancer according to the damage that one can see in the chromosomes of individual cases of bladder therapyo choose appropriately. there are presently chemotherapies used in the treatment of bladder cancer once surgery is no longer an effective tool, but we have not yet optimize the treatment of bladder cancer. unfortunately many people with advanced stages of the disease do die of bladder cancer. we believe that, as our understanding thing of the aggregates of genetic changes are better understood in individual cancers, bladder cancer being a good example, we will have much better tools of treating the disease and trying to keep it at bay.

host: is melanoma a preventable type of cancer? esco melanoma can be at least partially prevented. the main tool is reduced exposure to the uv damage and sunlight. we know from molecular studies is found in melanoma is a disease that varies dramatically among ethnic groups .n this country is much more frequent in the white population than in the african-american population. strategyain preventive is avoidance of uv exposure to sunlight. that being said, we have had advances in the treatment of advanced melanoma over the past few years. melanoma generally appears initially on the skin and and can be successfully treated with surgery in the majority of cases. but when the disease is

advanced, it becomes a very difficult disease to treat. over the last several years, there have been new therapies based either on specific mutations that are quite commonly encountered in that disease or, and this is an important development that has brought significant smoker through the use of what we call immunotherapies, modulation of the immune system so the immune system helps in troll the growth and even reverse the growth and size of melanoma tumors. these are major developments that illustrate the power of our new understanding of the immune system and the molecular changes that occur in our genome to try to control the disease. host: what is your background? your personal background, your experience over the years? guest: well, you want a brief bio? postcode yes. guest: i grew up on the south shore of long island.

i was trained in english literature at harvard. then went to medical school. twoceived an important years of training at the national institutes of health where i currently am. during that time, i learned to love basic research and understand the power of fundamental unfettered research to make deep discoveries that principles of biology. then i spent 20 years around the faculty of the university of california medical school in san francisco. nih director for about six and a half years during the 19 90's. ran a cancer center for a decade. now i have been here for three and a half years as the director of the national cancer institute . from stephen rynning is massachusetts with dr. harold varmus. caller: good morning. i have been recently diagnosed with a fast-moving skin cancer.

it is not a melanoma. i believe it is a carcinoma, if that sounds right. it was removed and there was a biopsy. now i will go back in to remove a little bit more of the tissue around it. is there anything in my biological, my genetic makeup? i would like to know that. i am really careful in the sun. so i am in the coasta the sun a lot, but i am careful and put sunscreen on. so i want to know about my genetic makeup. i do not want this to be a reoccurring thing. they doubted they could cut it out in one big shot, maybe they could keep me clean for some time. guest: first of all, let me say that i am sympathetic with your diagnosis. i am sorry you are having to go

through this. but i am glad you are under medical care. sounds like you're getting good care. i cannot be directly to your situation. i would not do that on the air in any case and i do not know all the facts of your case. i will say that with respect to your exposure to the sun, you should not feel that you are responsible for your cancer. if everybody were to protect themselves from sunlight, the incidents of melanoma and other skin cancers would probably go down. but-- it would go down, there are natural error-prone u fence that occur during the growth of our cells that make it very unlikely we will ever be able to get rid of cancer as the disease that affects many different organs. smoke ore did not exercise vigorously, avoided

alcohol, avoided obesity, avoided somewhat. still, cancer is going to be with us. in a sense, it is a product of the way in which our cells work. making mistakes when cells divide an inch in sick variation of our system. in that sense, cancer is a very deep disease that affects the fundamental properties of how cells are engineered. but there are effective ways to .ontrol the disease like yours you're in headed -- inherited case is notthis common. but there are individuals who may be at high risk because they carry an abnormality in their genes inherited from a parent

that predisposes them to certain kinds of cancers. most genetic changes that drive cancers are changes that occurred during one's lifetime. they made it a result of the errors that go on when our dna is copied in our cell divide or it may be the result of exposure causing substances radiation thatv causes genetic changes. it is a mixture of events that lead to cancers, some inherited, more occurring during life, and i think as long as you are in the hands of a competent physician who understands some of these rents a polls -- some of these principles and has experience in the treatment of the kind of cancer you are dealing with the, i think you will be in good shape. host: a tweet -- over -- are we

over diagnosing cancers like prostate and breast cancers? guest: in a word, yes. the difficult part is knowing which cases are being overdiagnosed. the numbers indicate, especially in the case of prostate cancer, which is no longer recommended by the task force for routine screening, perhaps in exceptional cases, has led to many diagnoses that lead to simply notthat are helpful and not lifesaving but damaging, resulting in loss of sexual potency, loss of bladder continents, and the deficits of treatment are currently outweighing the benefits. so that test is no longer recommended. the numbers are pretty clear that the overdiagnosed of early breast cancer happens in many

cases as well, and there are a number of things that are being thertaken to try to improve situation clinically. from the point of view the national cancer institute, the thing we are trying to solve is the question of how we can take these early abnormalities and tests to kinds of distinguish between those that are likely to evolve into life- threatening illnesses and those beniare simply the nine -- gn abnormalities that would not cause serious symptoms or life- threatening situations had they not been detected. we're talking with leading researchers about their areas of expertise at the nih. dr. harold varmus is the director of the national cancer institutes. al is joining us from cambridge, ohio. caller: good morning.

it is a pleasure to be able to talk to a doctor out here after working for 40 years at a good job but cannot seem to ever get to talk to a doctor. you have to make an appointment and describe your problem to a nurse and then get worked on by the doctor and no discussion at all. this is not ase substitute to going to your physician and being personally treated. heller cho i understand. if you things. you put so many things out on the table, it is hard to get it republican duncan who called for a nuclear strike against iran here two days ago. truey, moving on, isn't it that cancer has only been out there that we know of for the 300 years? and don't we need the sun to make vitamin d for our bodies?

guest: first of all, cancer has been around for a very long time . a book was published not long ago called "the cancer and the author, george johnson, talks about the evidence that dinosaurs had cancer. but cancer is found in many kinds of animals. it is found in the remains of egyptians varied -- buried several thousand years ago. it is a phenomenon of life, specially human life. there is a variety of factors that can increase the risk of any single individual developing cancer. by far the greatest in our society is use of tobacco. but obesity, lack of exercise, alcohol use, exposure to sunlight are among some of the causes. is not as -- asbestos

longer use but is another cause. yes marco we need vitamin d. it there are other ways to get vitamin d. modest exposure to sunlight is very different than the kinds of anosures that lead to ordinance numbers of mutations as a result of uv exposures. most people get plenty of vitamin d. deficiencies in vitamin d can't .e repaired i taking it orally host: how important is it to listen to your body? early detection and early wariness in terms of riveting or allowing you to live with cancer and it being treated, regardless of the type of cancer? cannotunfortunately, we answer the question. the tools for detecting cancers

before symptoms arrive vary dramatically from one cancer to another. and if you are among listeners of something we have not talked much about microsurgery -- about, surgery, that is very important to keep in mind. the point of early diagnosis is to identify life-threatening cancers before their life- threatening and then remove them in their entirety. that is still the best approach we have to cure the cancer. oft and intense radiotherapy localized tumors. for some cancers we do have tests that have been shown to save lives. that is particularly true of something we have not mentioned , which islonoscopies an alternative to frequent detecting of feces for blood. but these are both methods that are proven to save lives by detecting colorectal cancers at

an early stage when they can be cured by surgery. you want to have the prescribed testing, either for blood and so that by colonoscopy a tumor can be detected, even before becomes cancers or at an early stage of cancerous development. we know from the rapidly declining mortality rate of: cancer that this is a very effective way to approach that disease. host: dr. harold varmus is the director of the national cancer nih.tute, part of the thank you very much for sharing your expertise with our c-span audience. guest: my pleasure. host: we are going to continue for a few minutes just with your phone calls and we want to hear from you on the issue of cancer or medical research at nih.

in a few minutes, we will turn our attention to mental health issues. judy is joining us from gerard, pennsylvania. caller: good morning. i wanted to know if the people are aware of the john kansas cancer research foundation in pennsylvania. it deals with using radiofrequency waves to do strike cancer cells that are targeted by nanoparticles. curley at the m.d. anderson cancer institute is the lead researcher on the project. host: what are some of the conclusions or findings so far? caller: they are at the stage of going to large animal treatment now. they have 100% success in treating pancreatic and liver cancer. host: thank you. manned -- mary from florida, good morning.

caller: hello? ahead with your comments. we can hear you. caller: my son had a rare , and at age 10 in his first brain tumor took place. he had excellent care at children's hospital in boston. but the disease progressed until he was in his 20's and a researcher at the national cancer institute found out about his illness. so we were all tested at nih to look for a family component. the disease produces tumors. we all have two tumor suppressor genes and both were in activated. through the efforts of research that the national cancer institute did, they located the

very place where the tumor lost its genes, chromosome number three. my son received treatment there for many years with surgeries and radiations and at the final , the cancerillness within experimental drug which prolonged his life three more years. unfortunately he did die at age 42 a largem 10 to part of his life was wonderful his brain was intact and his intellect was fine. we had a wonderful man and mainly because of the help of the nih. i cannot say enough of them. host: thank you for your call and for sharing your story with the spirit we are rejoined by

another expert at nih. dr. thomas insel is the director of national institute of mental health. thank you for being with us here on c-span. why such a disparity between the treatment of medical illnesses and mental health issues? time it has long been difficult for many people to understand that mental illnesses are brain disorders. very much like any other brain disorder or disorders of any other part of the body. the history of this goes back centuries. it has been difficult for many people to really understand that when a disorder affects the psyche, it affects the way we feel about who we are in the way we think it behaved, but it is actually based on something that is happening in the brain. it is a physical process that is driving this. we tend not to understand it that way. it has taken really about a decade or two of really getting the kind of science we needed to make that case and to understand

the brain as being the basis of both normal and abnormal behavior. host: the president talking about the brain initiative, calling this the next major american project -- what is he talking about? guest: to put that into context, he was thinking about the last two great american projects in science. one was the apollo project to put a man on the moon. and then the human genome project. the next great american project is what he is calling the brain initiative. and that is an initiative that will involve several government agencies, among them nih and the defense advanced research project agency and the national science foundation as well as private partners to take our understanding of the brain and how it works and bring it up a notch. try to figure out a way to develop the tools to decode the

language of the brain. we have gone a long way recently, but we knew -- need to go much further much faster to understand the basis of how the brain works and how it sometimes does not work so well so that you end up with a brain that gives you alzheimer's or parkinson's or any of those disorders that were mentioned earlier. those are disorders that if you are going to really be able to make the kind of progress we want, we have got to understand the fundamentals of the organ involved. we do not understand the brain as well as we understand the heart, kidney, or the liver. the association hopes to put the brain into the focus of current research so we can really up the understanding of this organ and be able to make a difference for people with brain disorders. host: with regard to alter them are specifically, is that because people are living longer and more prone to alzheimer's and dementia later in life or are there other factors? guest: a good part of the

concern about alzheimer's is the change in demographics. it is becoming a more common problem. something that more than 5 million americans have been affected, and $200 million less going into this. we are concerned about how to do better. doing better here is not that different from what you heard from my colleagues. a lot of it is trying to figure out how to detect earlier. here is one of the real challenges as we think about tose disorders, from autism alzheimer's and anything in between, we have been diagnosing them based on behavioral change, based on symptoms, changes in the way people think and behave. one of the great insights of the last decade or so in these brain s to realize behaviors are the last thing to happen with brain disorders. the brain preserves function for

a long time. you do not develop the first signs of parkinson's disease until you have lost about 80% of your dopamine cells. with alzheimer's, we know the brain has been effective for at least a decade, maybe two. where we need to go is figure out a way to intervene much earlier in all of the disorders before the symptoms look of the behavioral symptoms emerge. approximately 1.5 billion dollars is the overall budget for the nih." stood $31 billion. what impact has sequestration had on your research? guest: i think we are down to .bout $1.4 billion it means that we are not able to fund a number of new grants. we would like to. we always stay around 500 new grants per year.

grants per year. we fell to 512 this year. 560e quite frank, i think is way below where we need to be. if you look at the cost of these disorders for the nation, and some of that is the emotional cost to families, but even just the economic origins that these disorders in tail, you have to ask the question -- what should we be spending in r&d? it certainly should be much more than $1.4 billion. host: david joining us from eugene, oregon. caller: i know when the dsm 5 came out, you had a concern about the validity of dsm diagnoses. i wonder what you think about that. guest: i have thought about it quite a bit. we have been trying to figure out how to do better on the

diagnostic side of mental illness. it is clear that as long as we base our diagnoses on behavior, as i just said, we are getting there late. the question is how to bring biology and a number of other kinds of measures to the table so that we can identify these disorders much earlier and began to intervene much earlier with much better outcomes. if you listened to my colleagues who have been on the show this morning, it is really interesting how, across-the- board, whether talking about infectious diseases, cancer, we do not talk about heart disease but it is even more true there -- the lesson we learned in medicine is the earlier we can intervene, the better the outcomes. when you diagnose as dsm does simply by presenting symptoms, you are always getting there late. host: our guest is a graduate from boston university. walk us through your background. guest: